Delaying Follow-Up Colonoscopy to Five Years is Safe, Study Shows
- Delaying the first follow-up colonoscopy from three to five years after the removal of advanced adenomas is safe and does not increase the risk of colorectal cancer or...
- The clinical trial evaluated a total of 10,799 patients with advanced adenomas across eight European countries, with more than half of the participants coming from Spain.
- Public health screening programs using fecal occult blood tests have broadened early detection, identifying and removing precancerous polyps before malignancy develops.
Delaying the first follow-up colonoscopy from three to five years after the removal of advanced adenomas is safe and does not increase the risk of colorectal cancer or death from the disease, according to a large international study published in The New England Journal of Medicine.
The Scale of the Clinical Trial
The clinical trial evaluated a total of 10,799 patients with advanced adenomas across eight European countries, with more than half of the participants coming from Spain. Colorectal cancer remains the most frequently diagnosed tumor in Spain when considering both sexes, registering roughly 44,000 new cases each year.
Public health screening programs using fecal occult blood tests have broadened early detection, identifying and removing precancerous polyps before malignancy develops. Approximately 45% of individuals who undergo a colonoscopy following a positive stool test present with polyps, and certain adenomas are recognized as direct precursors to colorectal cancer.
Surveillance Demands on Infrastructure
The study was jointly led by Rodrigo Jover, affiliated with the CIBER de Enfermedades Hepáticas y Digestivas (CIBEREHD) and the Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), alongside Michael Bretthauer from the University of Oslo in Norway.
Current medical guidelines have traditionally recommended routine surveillance colonoscopies at shorter intervals for patients deemed at higher risk of developing new adenomas or cancer following polyp removal. However, this rigorous surveillance strategy places a heavy operational toll on healthcare infrastructure. In Spain alone, more than one million colonoscopies are performed annually, with follow-up procedures after polyp removal accounting for 10% to 20% of that total.
Relieving Strain on Endoscopy Departments
Endoscopy departments face sustained high demand and extensive waiting lists, while patients endure unpleasant bowel preparations, lost work hours, and minor procedural risks despite the general safety of the test. Extending the surveillance interval to five years could alleviate these strains without compromising patient safety.
Luis Bujanda, a CIBEREHD researcher at the Asociación Instituto de Investigación Sanitaria Biogipuzkoa who participated in the study alongside Isabel Portillo, noted: The reduction of colonoscopias tendría beneficios tanto para el sistema sanitario como para los pacientes, al disminuir las listas de espera, el gasto sanitario y las complicaciones asociadas a las colonoscopias, así como el impacto sobre la actividad laboral y la calidad de vida de las personas sometidas a vigilancia.
Updating International Recommendations
Following the publication of these findings, the trial results have been shared with international organizations tasked with drafting clinical practice guidelines. These bodies have started evaluating the data to update their recommendations for monitoring patients who have had colorectal polyps removed.
